Objective:To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases.Methods:A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical University from January 2014 to October 2023.Results:Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Beh?et′s disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×10 9/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions:PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

Objective:To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases.Methods:A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children′s Health, Capital Medical University from January 2014 to October 2023.Results:Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Beh?et′s disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×10 9/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions:PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

Objective:To explore the application effects of a four-in-one blended teaching model integrating artificial intelligence, virtual reality, 3D printing, and case-based learning (CBL) in the clinical teaching of spinal tumors.Methods:We divided 89 students on training in the Department of Orthopedics of Peking University Third Hospital from September 2022 to August 2024 into control group ( n=47) and experimental group ( n=42). The control group adopted traditional teaching, and the experimental group adopted the four-in-one teaching model. At the end of clinical teaching, an artificial intelligence test and a questionnaire survey were administered to the students to evaluate the teaching effects. The two groups were compared using the independent samples t-test with the use of SPSS 27.0. Results:The experimental group was superior to the control group with significant improvements in the answer accuracy rate (66.67%, χ2=9.44, P=0.002), learning interest [(4.50±0.63), t=2.75, P=0.007], theoretical knowledge mastery [(4.64±0.69), t=7.74, P<0.001], clinical thinking [(4.48±0.71), t=9.08, P<0.001], practical skills [(4.13±0.89), t=2.69, P=0.009], scientific research innovation [(4.71±0.59), t=9.28, P<0.001], teacher-student interaction [(4.74±0.54), t=12.76, P<0.001], and classroom attention [(4.69±0.52), t=12.64, P<0.001]. At the same time, the students in the experimental group put forward numerous constructive feedback. Conclusions:The four-in-one blended teaching model combining artificial intelligence, virtual reality, 3D printing, and CBL can help undergraduate medical students better recognize and diagnose spinal tumors with a correct clinical thinking path, achieving good teaching effects.

Objective To explore the effects of methimazole on endocrine function in patients with hyperthyroidism at different neuregulin 4(NRG4)levels.Methods A total of 60 patients with hyperthyroidism admitted to Huzhou First People's Hospital from January 2022 to January 2023 were selected.According to the level of NRG4,they were divided into case Ⅰ group(NRG4<80ng/ml,28 cases),case Ⅱ group(NRG4 80-120ng/ml,18 cases)and case Ⅲ group(NRG4>120ng/ml,14 cases).The clinical efficacy,thyroid hormone levels,glucose and lipid metabolism indexes and adverse reactions of three groups were compared.Results The difference of total effective rate among three groups was statistically significant(χ2=10.836,P<0.001).There were statistically significant differences in thyroid-stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4)between groups,time points and interactions among three groups(P<0.05).TSH levels increased and FT3 and FT4 levels decreased in all three groups after treatment(P<0.05).One month after treatment,the levels of fasting blood glucose,2h postprandial blood glucose,glycated hemoglobin,total cholesterol and low density lipoprotein cholesterol in three groups were significantly lower than before treatment(P<0.05),and the differences in above indicators among the three groups were statistically significant(P<0.05).There was no significant difference in total incidence of adverse reactions among three groups(χ2=5.349,P=0.069).After treatment,NRG4 levels in three groups decreased significantly over time(P<0.05).There were significant differences in NRG4 levels among the three groups at different time points(P<0.05),and case Ⅰ group

Objective:To explore the effects of peripheral nerve injury(PNI)on neuropathic pain(NP)and memo-ry function in mice,as well as the activation of neurons in the paraventricular nucleus(PVT)of the thalamus,so as to provide a basis for studying the relationship between NP and memory impairment.Methods:Twenty one 8-week-old male C57 BL/6J mice were randomly divided into sham group and experimental group,and the routine spared nerve inju-ry(SNI)was constructed in the mice of experimental group.The pain behavior and memory impairment of mice after SNI were evaluated with hot plate and eight-arm maze behavioral tests.Pearson correlation analysis was performed to an-alyze the correlation between pain behavior and memory impairment.The c-FOS expression in PVT was detected with immuno-staining.Results:Compared with the sham group,the heat pain threshold of mice in the experimental group was significantly reduced(P＜0.001).The results of the eight-arm maze test showed that the total rest time was signifi-cantly increased(P＜0.001),and the working memory error was increased from 1 to 4 days after SNI(P＜0.01).Correlation analysis indicated that early working memory errors were negatively correlated with heat pain threshold after SNI(P＜0.001).The immunofluorescence revealed that the number of c-FOS positive cells in PVT increased signifi-cantly(P＜0.001).Conclusion:SNI can cause abnormal pain behavior and memory impairment in mice,and cause neuronal activation in PVT.This study provides a basis for neurons in PVT to participate in the regulation of memory impairment in the context of NP.

Objective:To explore the effects of peripheral nerve injury(PNI)on neuropathic pain(NP)and memo-ry function in mice,as well as the activation of neurons in the paraventricular nucleus(PVT)of the thalamus,so as to provide a basis for studying the relationship between NP and memory impairment.Methods:Twenty one 8-week-old male C57 BL/6J mice were randomly divided into sham group and experimental group,and the routine spared nerve inju-ry(SNI)was constructed in the mice of experimental group.The pain behavior and memory impairment of mice after SNI were evaluated with hot plate and eight-arm maze behavioral tests.Pearson correlation analysis was performed to an-alyze the correlation between pain behavior and memory impairment.The c-FOS expression in PVT was detected with immuno-staining.Results:Compared with the sham group,the heat pain threshold of mice in the experimental group was significantly reduced(P＜0.001).The results of the eight-arm maze test showed that the total rest time was signifi-cantly increased(P＜0.001),and the working memory error was increased from 1 to 4 days after SNI(P＜0.01).Correlation analysis indicated that early working memory errors were negatively correlated with heat pain threshold after SNI(P＜0.001).The immunofluorescence revealed that the number of c-FOS positive cells in PVT increased signifi-cantly(P＜0.001).Conclusion:SNI can cause abnormal pain behavior and memory impairment in mice,and cause neuronal activation in PVT.This study provides a basis for neurons in PVT to participate in the regulation of memory impairment in the context of NP.

Objective:To explore the application effects of a four-in-one blended teaching model integrating artificial intelligence, virtual reality, 3D printing, and case-based learning (CBL) in the clinical teaching of spinal tumors.Methods:We divided 89 students on training in the Department of Orthopedics of Peking University Third Hospital from September 2022 to August 2024 into control group ( n=47) and experimental group ( n=42). The control group adopted traditional teaching, and the experimental group adopted the four-in-one teaching model. At the end of clinical teaching, an artificial intelligence test and a questionnaire survey were administered to the students to evaluate the teaching effects. The two groups were compared using the independent samples t-test with the use of SPSS 27.0. Results:The experimental group was superior to the control group with significant improvements in the answer accuracy rate (66.67%, χ2=9.44, P=0.002), learning interest [(4.50±0.63), t=2.75, P=0.007], theoretical knowledge mastery [(4.64±0.69), t=7.74, P<0.001], clinical thinking [(4.48±0.71), t=9.08, P<0.001], practical skills [(4.13±0.89), t=2.69, P=0.009], scientific research innovation [(4.71±0.59), t=9.28, P<0.001], teacher-student interaction [(4.74±0.54), t=12.76, P<0.001], and classroom attention [(4.69±0.52), t=12.64, P<0.001]. At the same time, the students in the experimental group put forward numerous constructive feedback. Conclusions:The four-in-one blended teaching model combining artificial intelligence, virtual reality, 3D printing, and CBL can help undergraduate medical students better recognize and diagnose spinal tumors with a correct clinical thinking path, achieving good teaching effects.

Purpose The current study aims to elucidate the interrelationships among IREB2,FBXL5,iron ho-meostasis,and the therapeutic efficacy of neoadjuvant chemotherapy.Methods A total of 97 samples,classified into colorectal cancer neoadjuvant chemotherapy-resistant and-sensitive groups,along with their corresponding paracancer-ous normal mucosa were collected.The expression levels of FBXL5,IREB2,TFRC and FTH1 were detected by immu-nohistochemistry,Werstern blot and RT-qPCR.The contents of ferroptosis-related markers Fe2+,MDA,ROS and GSH were detected by applying the kit,and the levels of these markers were analyzed.The relationship between each factor in different colorectal cancer tissues and tumor regression rate and prognosis of neoadjuvant chemotherapy were ana-lyzed.Results(1)The expression of IREB2,FBXL5,TFRC and FTH1 in colorectal cancer was higher than that in normal intestinal mucosa(P＜0.05),and the expression of FBXL5 and FTH1 in colorectal cancer drug-resistant group was lower than that in the sensitive group,whereas the expression of IREB2 and TFRC was higher than that in the sen-sitive group(P＜0.05);(2)The correlation analysis showed a positive correlation between the expression of IREB2 and TFRC in the drug-resistant group,and a negative correlation with the expression of FBXL5 and FTH1 in the drug-resistant group.TFRC expression in the colorectal cancer resistance group were positively correlated(P＜0.05)and negatively correlated with the expression of FBXL5 and FTH1(P＜0.05);(3)the content of Fe2+and GSH was high-er than that of the sensitivity group in the colorectal cancer resistance group,and the level of ROS was lower than that of the sensitivity group(P＜0.05);(4)Fe2+was positively correlated with the expression of IREB2,TFRC,and neg-atively correlated with the expression of FBXL5 and FTH1,and was negatively correlated with the expression of FBXL5 and FTH1.FTH1 expression were both negatively correlated(P＜0.05);(5)tumor regression rate was positively cor-related with the expression of FBXL5 and FTH1,and negatively correlated with the expression of IREB2 and TFRC,as well as positively correlated with the level of ROS,and negatively correlated with Fe2+and GSH(P＜0.05);(6)The expression of IREB2 and TFRC was positively correlated with tumor diameter and lymph node metastasis,and the ex-pression of FBXL5 and FTH1 was negatively correlated with tumor diameter and lymph node metastasis,and the expres-sion of FBXL5 was also negatively correlated with the depth of tumor infiltration(P＜0.05);(7)Kaplan-Meier analy-sis showed that lymph node metastasis,FBXL5,IREB2,TFRC,FTH1,and TRG grading were closely related to the prognosis of colorectal cancer patients(P＜0.05).Cox multivariate regression analysis indicated that lymph node me-tastasis,high expression of IREB2 and TFRC,low expression of FBXL5 and FTH1,and low tumor regression grade(TRG)were risk factors for the ineffectiveness of neoadjuvant chemotherapy in colorectal cancer patients.Conclusion FBXL5 and IREB2 are not only associated with high iron homeostasis,but also closely related to the efficacy and prognosis of neoadjuvant chemotherapy for colorectal cancer.In the future,they may become new targets for the treat-ment of colorectal cancer and improve the prognosis of patients.

Objective To explore the effect of exenatide on oxidative stress in the hypothalamus of diabetes mice and its potential mechanism.Methods After one week of adaptive feeding,C57BL/6J mice were randomly divided into the CON group(normal chaw diet),the T2DM group(high-fat diet,HFD),and the T2DM+Exe group(HFD+exenatide).After 8 weeks of HFD,mice in the T2DM+Exe group were intraperitoneally injected with exenatide[24 nmol/(kg·d)]for 8 weeks.The weight and glucose and lipid metabolism levels of the mice were measured,and the levels of inflammatory and adipokine factors in mice were detected using the ELISA method.Western Blot was used to detect the expression of melanocortin receptor-4(MC4R)and proopiomelanocor-tin(POMC)in the hypothalamus.Hypothalamic mitochondria were extracted,and the content of mitochondrial reactive oxygen species(ROS)was measured using a flow cytometer.The content of malondialdehyde(MDA)and the activities of superoxide dismutase(SOD)in the mitochondria were detected using assay kits.Changes in the ultrastructure of mitochondria were observed using a transmission electron microscope.In vitro experiments,pal-mitic acid(PA)and exenatide were used to treat hypothalamic GT1-7 cells,and short hairpin RNA(shRNA)was used to silence the melanocortin 4 receptor(MC4R),and observe the cellular oxidative stress and lipid deposition.Results Compared with the CON group,the T2DM group mice showed a significant increase in glucose and lipid metabolism indicators,pro-inflammatory factors,and adipose factor levels(P<0.05),the expression of MC4R and POMC proteins in the hypothalamus were decreased(P<0.05),and the mitochondrial ROS and MDA content in the hypothalamus significantly were increased(P<0.05),while SOD and CAT activities were decreased(P<0.05).Mitochondrial morphology was abnormal.After intervention with exenatide,the above indicators were signifi-cantly improved.After inhibiting MC4R expression in vitro experiments,compared with the intervention group with exenatide,the ROS and MDA content was significantly increased(P<0.05),SOD activity was decreased(P<0.05),and lipid deposition occurred in the cells.Conclusions Exenatide exhibits a protective effect on hypotha-lamic oxidative stress injury in diabetic mice,and this mechanism may be associated with the upregulation of MC4R expression.

Objectives:To explore the long-term follow-up prognosis and risk factors in patients with neuro-logical function deterioration after expansive open-door laminoplasty at early postoperative stage(within 3 months).Methods:A retrospective analysis was conducted on 17 patients who experienced neurological func-tion deterioration(the mJOA score decreased by ≥ 1 point at postoperative 3 months'follow-up compared with that before operation)at early stage after receiving laminoplasty with the preservation of unilateral muscle-lig-ament complex in our department between January 2006 and December 2012.The patients were divided into non-recovery group(n=5)and recovery group(n=12)based on whether the mJOA score of one patient recovered to one's preoperative level at postoperative 10-year follow-up.The baseline data,perioperative information,postoperative 3-month,1-year and 10-year mJOA score,neck disability index(NDI)score,and visual analog scale(VAS)score,as well as the imaging data[Cobb angle,range of motion(ROM)of the cervical spine,and sagittal vertical axis(SVA)of C2-C7]were collected and compared for regression analysis.The differences be-tween different mJOA categories involved between the two groups were also compared.Results:The proportion of patients with ossification of longitudinal ligament(OPLL)in the non-recovery group was significantly higher than that in the recovery group.There were no statistically significant differences between the two groups in baseline information such as age,gender,BMI,comorbidities,spinal cord T2 high singnal intensity and devel-opmental cervical canal stenosis,as well as perioperative information such as operative time,blood loss and the length of hospital stay(P＞0.05).One patient in the non-recovery group had experienced cerebrospinal fluid leakage and C5 nerve root palsy and 1 patient in the recovery group had experienced cerebrospinal fluid leakage,and the difference wasn't with statistical significance between the two groups.After neurological dete-rioration occurred within postoperative 3 months,imaging examinations were conducted on all the patients and found none insufficient decompression,therefore no secondary surgical treatment was performed.The preopera-tive mJOA scores of the non-recovery group and recovery group were 13.30±2.46 and 14.71±1.41,respective-ly,with no statistically significant difference between the two groups.After early postoperative neurological function deterioration,the mJOA score at 1-year follow-up in the recovery group significantly improved com-pared to that at 3-month follow-up,which wasn't significantly different from the preoperative level,and the mJOA score at 10-year follow-up was significantly higher than the values before surgery and at previous fol-low-up visits.However,in the non-recovery group,the 1-year and 10-year follow-up mJOA scores weren't statistically different from the value at 3-month follow-up.There was no statistically significant difference in VAS scores and NDI scores between the two groups before surgery and at each follow-up;The intragroup comparison of VAS scores and NDI scores in both groups showed no significant difference between different time points.In the recovery group,the Cobb angle increased at each follow-up compared to the preoperative value,and SVA increased significantly at the 10-year follow-up.In the non-recovery group,there was no statistically significant difference in Cobb angle and SVA at each follow-up compared with the preoperative values.The ROMs at postoperative follow-up visits of the recovery group decreased significantly compared to that of preoperation,while no such difference was found in the non-recovery group.In addition,there were no significant differences in Cobb angle,ROM,and SVA between the two groups at preoperation and each follow-up.It was found that the patients in the non-recovery group were more likely to have the sensory function of lower extremity affected in neurological deterioration at postoperative early stage.The logistic re-gression results suggested that OPLL before operation was a risk factor for early postoperative neurological de-terioration that was hard to recovery at 10 years of follow-up.Conclusions:The patients with cervical OPLL before operation who suffer from early postoperative neurological deterioration after laminoplasty tend to be more difficult to recover in the long-term follow-up.